Last week, I had the opportunity to attend the European WASH and NTDs Roundtable hosted by SHARE Research Consortium. The event brought together academics, donors and NGOs, with the aim of significantly progressing collaboration, coordination, and cooperation between the water, sanitation and hygiene (WASH) and neglected tropical diseases (NTDs) sectors. The roundtable focused on the areas of mapping, data collection, monitoring, and research.
Although sometimes overlooked, the WASH and NTDs sectors are greatly interconnected. Half of all NTDs, which result in malnutrition, child stunting, impaired cognitive function, disability, and even death, are related to WASH. Access to safe WASH plays an important role in breaking NTDs transmission cycles and preventing disease. Additionally, improved WASH is required for NTDs wound and disability management – without it, individuals infected with disease are left even more vulnerable. Collaboration between WASH and NTDs sectors is clearly important and mutually beneficial.
Day 1 of the roundtable focused on developing joint sector measures and indicators for monitoring. This is a clear topic of interest to WASHwatch.org, which aims to strengthen WASH sector transparency and monitoring for improved accountability.
Participants worked in small groups to focus on developing joint indicators for either water and NTDs, sanitation and NTDs, or hygiene and NTDs. Discussions in groups focusing on sanitation or water and NTDs similarly centred on reflecting on current monitoring mechanisms; identifying gaps, and finding solutions for how to better use existing data for joint sector monitoring and reporting.
More specifically, participants reflected on the need for WASH monitoring to move beyond access to improved drinking water sources and sanitation facilities in order to adequately reflect both sectors’ interests.
It became clear that water-related indicators would need to consider different uses of water (e.g., for hand washing, bathing, and domestic chores), the quantity of water available for all uses (including hygiene and wound management), and the true quality of water in use (i.e., through water testing rather than assumed quality based on water source type).
In terms of sanitation, participants said that indicators would need to adequately capture vector control measures of sanitation facilities (vectors, such as flies, can be carriers of disease and facilitate transmission), the true environmental protection of facilities (i.e., through soil testing rather than assumed protection based on facility type), and the use of excreta after the point of defecation (e.g., treatment and disposal, or re-use of excreta).
In contrast to sanitation or water and NTDs groups, those focused on hygiene and NTDs put forward specific indicators for collaboration. This could have been expected given the vast gap in current monitoring mechanisms, which exclude hygiene. Joint indicators put forward included:
- Proportion of people hand washing at key times with soap or ash;
- Proportion of children with clean faces through proper washing;
- Proportion of people regularly practicing personal hygiene in non-surface water;
- Proportion of people who wear appropriate footwear;
- Proportion of compounds that are clean, i.e., open defecation free; and
- Proportion of people with sufficient knowledge about hygiene practices.
The roundtable undoubtedly stimulated the development of concrete ideas for progressing joint WASH and NTDs sector indicators. At the close of the roundtable, there was consensus that the NTDs sector was interested in incorporating WASH indicators. However, the level of interest from the WASH sector to incorporate relevant health indicators was generally perceived to be low. So, how can we mobilise the WASH sector to incorporate such indicators?
Perhaps it’s a simple question of sector reflection: why do we do what we do?
It’s not to build latrines, tippy taps and bore holes. It’s to protect dignity, and, largely, health.
If the purpose of our work goes beyond delivery of services to include health promotion, can we hold ourselves accountable if we don’t measure the impacts of WASH on health? Improved sector accountability should be reason enough to support health indicators in monitoring, but in case you need another incentive, consider the wider support (and funds) for WASH we could garner if we were able to measure impact outside of access.
With the Sustainable Development Goal (SDG) process underway, we have the opportunity to secure health indicators in WASH monitoring. Perhaps the opportunity for success lies in consolidating WASH, public health, and human rights messaging.
Health measures for WASH do not need to be indicators of ill health, as distribution and characteristics of disease data already exists. Rather, indicators would need to speak to the impacts of WASH on health risks.
Impacts of WASH on health risks would measure the true environmental and social protection expected to be delivered with WASH. Current monitoring, which assumes protection by existence and use of improved WASH facilities, does not adequately measure these WASH impacts. Reports of failed environmental, social, and thus, health protection of improved WASH services are not uncommon.
Proposed targets and indicators for post-2015 offer welcome improvements, and are well aligned with findings from the roundtable. This presents an opportunity for the public health sector to refine post-2015 indicators to include their interests.
An additional opportunity for collaboration between WASH and health sectors presents in human rights discourse. The human right to water and sanitation, which includes relevant public health messaging such as, sufficient and safe water for domestic uses as well as drinking, and defines sanitation to include safe treatment and disposal, or re-use of excreta, is being heavily lobbied for formal recognition in the SDGs.
Pooling similar voices from WASH, public health, and human rights advocates to align messaging would result in a stronger influence on sector monitoring in the SDG framework. Joining forces for improved monitoring would benefit all political agendas, and only ensure improved sector accountability in the future.
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Reflection Question for Comment:
To include public health and human rights perspectives would the proposed post-2015 WASH indicators need to be altered?
If yes, how? Would they be feasible? If not, why?